This chapter offers a critical consideration of behavior change scholarship. It introduces the complexity of behavior change and provides a brief overview of major concerns that have been raised regarding behavior change theories and models. It then discusses how critical and qualitative approaches can provide a response to some of these concerns and how qualitative approaches have value for extending practice in this field. The chapter provides arguments for using qualitative research in behavior change research, gives examples of where qualitative approaches have been employed, and outlines social practice theory as a means to address many of the concerns about dominant approaches to behavior change. The chapter also discusses critical perspectives and their value to the field of behavior change research and implementation. In the final sections, the chapter outlines the benefits of researchers and practitioners working interdisciplinarily, advocates the importance of understanding and incorporating qualitative approaches into behavior change research, and highlights the value of taking a broader, more critical perspective on research and practice in this field.

Learning objectives

The aim of this chapter is to review research on what influences people to seek health care, and what factors influence the quality of the interaction they have with health professionals. By the end of this chapter, you should be able to:

• identify factors that influence when and why people seek health care;

• discuss some of the functions of patient–health professional interaction;

• describe influences on the quality of patient–health professional interactions, including those at the individual, social and cultural level;

• offer an analysis of the ways in which power operates within interactions with health professionals;

• critique the current state of research into patient–health professional interaction;

• outline some of the implications of traditional patient–health professional interaction research;

• offer suggestions for future research in this area.

Learning objectives

This chapter reviews factors that influence people becoming ill. We examine research investigating whether psychological factors, such as stress and personality, play any role in disease causation. The chapter also provides a review of social and environmental factors that influence becoming ill, such as social support, gender and SES. Some physiological pathways through which psychosocial factors could influence physical health are described. Finally, we present examples of research which attempt to integrate this somewhat disjointed field through meta-level theorising. By the end of this chapter you should be able to:

• identify key psychological factors which influence people becoming ill;

• explain how sociocultural factors, such as gender, ethnicity and SES, need to be accounted for in any account of illness causation;

• provide an outline of how environments affect disease causation;

• discuss the implications of traditional health psychology research on psychological factors and disease processes;

• highlight the necessity for effective and integrative ‘biopsychosocial’ theorising in disease etiology.

Does stress influence health? Are people who repress their emotions more likely to develop cancer? Is there a disease-prone personality?

Learning objectives

This chapter focuses on behaviours that are part of an individual's lifestyle, such as eating, smoking, drinking, taking drugs, using condoms and so on. It reviews different approaches to attempts to influence lifestyles (through health promotion efforts) and reviews research on the contextual nature of individual behaviour. By the end of this chapter you should be able to:

• identify and describe social cognition approaches to the study of lifestyle behaviour;

• compare and contrast individual and structural-collective perspectives on improving lifestyles and health;

• outline and explain some of the limitations of traditional approaches to health promotion efforts;

• describe the implications of strategies that have been employed to influence individual lifestyles;

• explain the importance of social situation and cultural context in understanding behaviours that make up individual lifestyles.

What are lifestyles and how do they relate to health?

What kind of lifestyle do you have? Reasonably affluent, relaxed, busy, ‘on the edge’, chilled out, stressed, fun, sporty? Does your lifestyle affect your health? Will it affect your health one day in the future? Do you ever think about changing your lifestyle for health reasons? What does a ‘healthy’ lifestyle mean? Does it equate with doing nothing that is exciting or fun?

Learning objectives

This chapter will provide an introduction to health psychology and locate studies of health and illness within their sociohistorical context. By the end of this chapter, you should be able to:

• provide a brief historical overview of dominant Western views on health and disease;

• outline the historical development of psychological approaches to health and illness, and health psychology in particular;

• define and explain the biomedical and biopsychosocial models of health and illness;

• describe what health psychology covers as a field of study;

• […]

There are many reasons why we feel that a book like this is overdue. We have both been teaching health psychology and searching for a text that takes a more critical approach to notions of health and illness, without success. Although there are many health psychology texts available, and more keep appearing, none seems to us to be suitable for the ways in which we want to approach health psychology, either as researchers or as teachers. Existing health psychology texts do not reflect the changes in this field, where increasingly a variety of methods and approaches, qualitative and critical, are being employed to examine health and illness issues from a psychological perspective. For some years we have felt dissatisfied with the ways in which health psychology conducts its research and promulgates its findings. We are critical of the way it unreflexively continues the traditions of mainstream psychology, assuming that psychological factors have a real existence, that they can be meaningfully and accurately measured, that statistical findings have meaning by virtue of their significance levels and that findings (almost) have the status of general laws. We are critical of the lack of consideration in health psychology of the social context within which health and illness are experienced and understood. We are critical of the way in which health psychology all too readily adopts the premises and assumptions of biomedicine, and the ways in which its findings promote biomedical understandings, albeit in the guise of a ‘biopsychosocial’ approach, a vague rhetorical entity with many meanings.

Learning objectives

The aim of this chapter is to consider the experience of illness, including factors that are important in adjusting to and recovering from illness, approaches taken to researching and theorising being ill, ways in which illness is presented, and issues involved in caring for ill people. By the end of this chapter you should be able to:

• describe the extent of illness in contemporary Western society;

• critically evaluate research on coping with illness;

• outline the various ways in which people with illness find support;

• discuss how illness can have positive as well as negative effects;

• outline arguments for and against considering illness as a crisis requiring adjustment;

• explain what is meant by quality of life and discuss its value in research on illness;

• […]

Learning objectives

This chapter outlines ideas about health and the body, and how people think about these constructs. It will set notions of health and the body within social and cultural contexts. By the end of this chapter, you should be able to:

• describe different definitions of health;

• explain the interrelationship between health and illness;

• compare and contrast ‘lay’ and ‘expert’ understandings of health;

• describe how notions of health and the body vary across social categories;

• define embodiment and outline its importance for understanding health;

• discuss the relevance of the body for health psychology;

• consider the ways in which knowledge about health and the body is socially and historically constructed.

What does it mean to you to be healthy? Are you healthy right now? Why or why not? How would you define health? Is your definition likely to be the same as your friends' definitions? What about your grandmother's or father's definitions? Are your ideas about illness related to your definition of health? Are ideas about health important? Before we study health as a topic, we need to be clear about what it means.

Learning objectives

This chapter introduces ideas about individuals' understandings and relationships with their bodies, and the body as a site which can be examined and controlled in order to maintain physical health. Thus, behaviours such as breast and testicular self-examination, screening for disease and genetic screening are considered. We discuss the implications of the current pervasive focus on disease risk, self-surveillance and engagement with technological screening programmes. By the end of this chapter you should be able to:

• distinguish between primary, secondary and tertiary prevention efforts;

• describe some of the major forms of secondary prevention of disease;

• evaluate whether screening programmes have a psychological impact;

• outline the costs and benefits of screening programmes;

• identify factors which influence individual uptake of screening services;

• describe the major types of genetic testing currently employed, as well as their psychological and social effects;

• discuss the implications of secondary prevention approaches for the individual;

• examine how secondary prevention practices influence individual perceptions of risk;

• evaluate how morality is embedded within accounts of risk.

Learning objectives

The aim of this chapter is to reflect on health psychology as a field, and to consider the approach taken to health psychology in this text. We consider the critical perspective taken, and how this influences conceptualisations of, and research on, health and illness. By the end of this chapter you should be able to:

• show an understanding of the traditional approaches to health research and their limitations;

• discuss social influences on health and illness;

• reflect on alternative possibilities for research into health and illness;

• outline challenges and opportunities for improving health from a global international perspective;

• explain what is meant by a ‘critical’ perspective on health and illness research;

• compare and contrast ‘critical health psychology’ with ‘mainstream health psychology’;

• describe the requirements for enabling health psychology to enhance its contributions to the health and well-being of individuals, communities and societies.

Learning objectives

The aim of this chapter is to consider research relating to various forms of treatment for illness, and issues which are important in treating illness. By the end of this chapter you should be able to:

• provide an overview of the different forms of treatment for illness;

• outline the different sectors of health care and their approaches to treatment;

• discuss the research on self-treatment for minor illnesses;

• describe the reasons that people give for seeking treatment from health professionals;

• review the psychological issues in treatment for serious acute illness in hospital;

• discuss the psychological factors involved in self-care for chronic illness;

• discuss the issues involved in non-conventional treatment;

• explain the different approaches to and meanings of adherence;

• discuss the nature of the placebo effect;

• comment critically on who receives treatment and structural issues affecting access to treatment;

• outline the changing nature of treatment.

Learning objectives

The aim of this chapter is to review the literature on how people interpret and respond to bodily sensations which have implications for physical health. By the end of this chapter you should be able to:

• provide an overview of psychological research on recognising symptoms;

• offer a critique of the biomedical model of symptom recognition;

• distinguish between a ‘bodily sign’ and a ‘physical symptom’;

• argue why cognitive factors involved in perceiving changes in bodily states need to be understood within a social and cultural framework;

• describe and critique the main theories of pain;

• discuss the implications of constructing factors that influence bodily experience as located within the individual;

• compare and contrast differing accounts of the body and bodily experience.

Learning objectives

By the end of this chapter you should be able to:

• discuss variations in mortality and influences on rates of death;

• describe different types of death and the changing constructions of death over time;

• comment on the ways in which a ‘good death’ is constructed;

• review research on how people face death and adjust to dying;

• discuss bereavement and the relation of the bereaved to the deceased;

• comment on the role of medical technology in death and dying;

• outline the effects of dying on health professionals and caregivers;

• argue why death and dying are essentially social processes.

In health research, particularly in epidemiology, death is often taken as a ‘hard’ data point, a status that cannot be disputed – a person is either dead or alive. However, dying is much more complex than this. There is substantial variation in rates of death around the world; the pace of death varies by country, by ethnicity, by gender, by age and by SES. Further, the process of dying can be highly variable. A person dying slowly from emphysema goes through a very different experience from a person who dies suddenly from a heart attack; a person dying peacefully in his or her sleep at home aged 85 is understood quite differently from an 18-year-old dying in agony in a car accident. Some people want to die and others resist dying.